Ozempic Face: A Trade-off for Significant Weight Loss?

It seems like everyone is taking Ozempic/Wegovy (semaglutide, Novo Nordisk) or Mounjaro (tirzepatide, Lilly) for weight loss these days, and many are reporting a side effect dubbed “Ozempic face” by the media.

Facial plastic surgeons are seeing an uptick in patients concerned that rapid weight loss is causing their facial skin to sag and make them appear older.

First approved to treat diabetes under the brand name Ozempic, semaglutide received the FDA's nod as a weight-loss medication in June 2021 with the brand name Wegovy. Mounjaro (tirzepatide) was fast-tracked for weight loss by the FDA in October 2022 and may be approved sometime this year. These are all injectable medications known as glucagon-like peptide-1 (GLP-1) receptor agonists. Tirzepatide also contains a glucose-dependent insulinotropic polypeptide receptor agonist in addition to a GLP-1 receptor agonist. 

“We are definitely seeing 'Ozempic face' in the office because these drugs work so well,” says Jason Bloom, MD, a facial plastic surgeon at Bloom Facial Plastic Surgery in Bryn Mawr, Pennsylvania. “Patients are coming in mainly because of fat loss in the buccal space and submalar and submental regions,” he says. The largest clinical trial showed that adults taking semaglutide lost an average of almost 15% of their initial body weight, and studies show that Mounjaro may be able to induce a 21% loss of body weight.

“There are huge health benefits to weight loss, especially if you have comorbid conditions like high blood pressure or diabetes, and the price to pay is that you lose volume in the superficial and deep fat pads in the face.”

What is 'Ozempic face'?

Ozempic face is the result of rapid weight loss that can happen as a result of taking semaglutide, says Michael Somenek, MD, a facial plastic and reconstructive surgeon in Washington DC. “It is analogous to a rapid deflation of the tissues, with the face taking the hardest hit, and this leads to more noticeable laxity and a more gaunt or drawn look. “

Not everyone complains about Ozempic face.

“Some people feel that weight loss creates a more sculpted look, like removing buccal fat, but the face can also look more ‘saggy’ as the result of volume loss, and rapid weight loss and gain can make the skin and other tissue lose its elasticity,” adds Jennifer Levine, MD, a facial plastic surgeon in New York City. 

(Buccal fat removal is another big trend in facial plastic surgery today. Watch Joe Niamtu, DMD, debunk some of the myths surrounding this procedure.)

American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) President Theda Kontis, MD, says these changes are similar to facial changes seen in people who have had massive weight loss, such as those who have undergone bariatric surgery.

“The face has fat pads that can enlarge with weight gain and diminish with weight loss,” says Kontis, a facial plastic surgeon in private practice in Baltimore. “As we age, the natural process is for those fat pads to diminish in size. This is why facial fillers are so popular.“

Facial volume changes are the first sign of significant weight loss, and patients might complain of this early on in the weight loss process, says Corey Maas, MD, the founder of the Maas Clinic for Aesthetic and Facial Plastic Surgery and Research Center at the Maas Clinic in San Francisco or Lake Tahoe, California. 

"We have been seeing patients with drug-related lipoatrophy in the face for decades," he says. For example, many of the early HIV drugs caused uncontrolled lipodystrophy characterized by facial wasting.

Innovative ways to address facial weight loss

Ozempic face can be addressed with dermal fillers or collagen stimulators, Somenek says. “Additionally, for the skin laxity, some other measures may need to be used, including skin tightening devices like microneedling radiofrequency, laser resurfacing, and in more severe cases, surgical skin tightening procedures like a neck lift,” he says.

Fat grafting is another option. “Fat is a little bit more finicky than filler,” Bloom says. “Some of the muscle and skin is going to droop with weight loss, so some patients may need a face or neck lift.”

There is also a role for other energy-based devices such as Ultherapy (Merz Aesthetics) and Emface (BTL), which can also target the deeper tissue, Levine adds.

Long-term effects of GLP-1 receptor agonists

There may be more side effects seen with long-term use of these medications, and it’s still too early to say what happens when a person stops taking them. “We certainly need more long-term data to assess the most effective way to manage this drug long-term with patients,” Somenek says.

“Once the person stops taking Ozempic, they usually regain the weight that they lost, but that does not mean that it is redistributed to the face,” Levine says. “It will not help you regain the volume or elasticity that was lost.”

Maas agrees. “There are a handful of patients who will gain some weight back, but generally this is not done at a rate that is significantly less than the weight loss rate,” he says. “This means that it would be highly unusual to have to remove, adjust, or modify the fillers that have been used to restore facial volume [in any significant way].”